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r� FOR OFFICE USE. -._ 1_�-3--.�� Permit No. _. - � APPLICATION FOR SANITATION PERMIT I--- - (Complete in Duplicate) � Date Issued J--_'=�•�-�---=�� _ _ This Permit Expires 1 Year From Date Issued Application is hereby made"� o the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATI N___ - -: -_.. Phone------------------------------- Owners Name ------------- - - t ----------•------------ •___-.------- •-------------------- Address----- �- - ---- ------------------------ ------------------------------------------ . . fiPhone------•---------------------------- Contractor's Name__ --___. ------------------------------------ -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [IOther E] ._ Number of baths A.-.. Lot size _�f Number of living units: -�-{.- Number of bedrooms � L - � �-- ------------------------------ - Water Supply: Public systerrs _1i Community system ElPrivate Ej� epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W�ardpan ❑ Previous Application Made: [if yes,date-..-------- No Z?'New Construction: Yes ❑ No 0' FHA/VA: Yes ❑ ;,No TYPE OF INSTALLATION -AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta/nka Distance from nearest well____._-__.___-Distance from foundation------------------- No. of compartments------ ---- ----------Size--------------- ------------ ---Liquid depth---------------------- .--Capacity--•-------------------- Disposal Figld: Distance from nearest well_________________Distance from foundation--------------------Dist ance to nearest lot line------------- Number of lines--------------_- ------- - -------Length of each line------------------------------Width of trench------------- --------------------- p\, Depth of filter material------------- ----- ---------Total length------------------------------------ Type of filter material____.--____-.._____.-- ! �- Distance from foundation_t3l9_.___.___ Distance to nearest lot line_____ ___________ Seepage.Pit: Distance to neares�well._. e9,0_--- -- � De th-_q�/ id---__ Number of pits_____ ______________Lining material_6_,--.Size: Diameter-_- __ _--_____-._.-- p of-7- Number i --- Cesssppoa Distance from nearest well-----------------Distance from foundation-------------------Lining material------------------------------------- El 11 Diameter----------------------- -----.Depth----- ----------------------- ---------------------Liquid Capacity --------------------------gals. �I Priv Distance from nearest well____...__-__--____ ------------------------ ---_Distance from nearest building_________ ______________________-..._. y: - Distance to nearest lot line --------- ----------- --- --------- �---------------------------------- - -- ----------------------- El y Remodeling and/or repairing (describe)_--------------_----------e --- -- :060— ___________•_•-------------------------------------------------------- ---------- -------- --------------------------------------------------------------- -------------------------------------------- ----------------------- -- --------------------- - --- = --------- - I hereby certify that.1 have prepared this application and that the work will be done in accordarice with San Joaquin ounty ordinances, State laws, acid rules and regulations of the San Joaquin Local Health District. --- Gktam=m=*4e}'Contractor) (Signed)_ - -- ------- ------ -- Tale (Plot plan, showing size of lot, location of system in re • n to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY ZA APPLICATION ACCEPTED BY---------------------------- DATE----------- 2 3 __M_ --- - - - --. DATE--------�----------------------------------------- ----- -- REVIEWED BY---- ------------ ----------------------- --- ---- -- DATE I S =moi - 1 BUILDING PERMIT ISSUED____________________- - - Alterations _Alterations and/or recommendations:--------------------------------- ------- ---------------------------•----- ------------------------------ 1 �. ��- ------------ ------------ - ,�) -------- Date----- --------r ----- - .. FINAL INSPECTION BY------------ --- -- ----`-�-------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.